For people who live with mental illness and do not have access to significant financial resources or are uninsured or underinsured there is a hard reality that must be faced.

No one is coming to help.

Mental healthcare services in the U.S. and other developed countries has been in decline for decades, and it’s only getting worse. A review of the past 30 years of mental health research and data clearly indicates Americans do not have access to the care they need and that there is a need for practical, evidence-based resources people can use when clinical/social services are limited or unavailable.

In 2019-2020, 20.78% of adults were experiencing a mental illness. 

That’s equivalent to over 50 million Americans and a number that has not declined since 2011.

Over 1 in 10 youth in the U.S. are experiencing depression that is severely impairing their ability to function at school or work, at home, with family, or in their social life.

Almost a third (28.2%) of all adults with a mental illness reported that they were not able to receive the treatment they needed.

Youth who experience severe depression often struggle with co-occurring substance abuse and anxiety, but over half don’t receive treatment, which advocacy groups link to an alarming increase in suicide among younger people.  

I wish the idea that no one is coming to help was hyperbole born out of a general dissatisfaction with the state of mental healthcare, but it’s not. Quantitative and qualitative evidence clearly demonstrate that the situation has been, is, and will continue to get worse; that’s not nihilism, it’s simply where we are right now as a country and having experienced the mental health system as a leader and a patient, I can honestly say it is not going to change soon.

In an America where suggesting we ought to help people who are suffering gets you labeled a Stalin-era Communist, it’s absurd to expect the system to be reformed in any meaningful way by those with the power to do so.

I could be wrong, and hope I am, but more awareness of the crisis has done little to improve the quality, access, and affordability of mental healthcare services.

I also wish the issue were not political, but politics and economics do play a significant role in a person’s ability to access mental healthcare services, so must be addressed in that context. The systems in America intended to help people with mental illness will continue to degrade as business and political interests systematically override any national commitment to the common good.

While mental health is being discussed more openly as a social issue, policy makers, insurance companies, and drug manufacturers have done little to improve the lives of those who struggle with mental illness, and demonstrate no interest in doing so in the future.

In an America where suggesting we ought to help people who are suffering gets you labeled a Stalin-era Communist, it’s absurd to expect the system to be reformed in any meaningful way by those with the power to do so. When asking why we can’t create a more just, sustainable mental healthcare system causes many politicians and the people who voted for them—people who faithfully vote, again and again, against their own self-interests—to erupt in fits of red-faced, hysterical rage, it’s clear, at least for right now, we’re on our own.

America has been shedding its commitments to the common good for decades, and in the last 20 years a particularly nasty strain of cruel libertarianism has poisoned the roots systems of many federal, state, and local governments.

This mutation combines a gross misreading of libertarian beliefs about zero government involvement in the social order with rabid support of corporate welfare policies that enrich a small portion of the population while generating huge campaign war chests for any politician willing to parrot a false narrative about the evils of socialism.

The leadership bar is set far too low for us to expect those in power to restore the kind of order and compassion needed to have a tangible, sustainable impact on the mental healthcare system.

America’s inability to break with pay-to-play politics and the policies that are advanced under this system have created staggering wealth and resource disparities. 10 years ago, politicians who wanted to game the system or abuse their power at least made passing efforts to keep it a secret. Now, open hostility towards facts, minorities, women, the poor, LGBTQ community members, and science on the part of elected officials has become an acceptable part of our barely functioning democracy. The leadership bar is set far too low for us to expect those in power to restore the kind of order and compassion needed to have a tangible, sustainable impact on the mental healthcare system.

In recent years, the normal cynicism, graft, and self-centered hypocrisy Americans have come to accept from lawmakers and corporations has been replaced by a callow, sadistic form of cruelty that takes shameless delight in everything from denying 9-11 first responders healthcare benefits to forcing children who are the victims of rape to bear children.

The events following the election in 2016 through to the attempted overthrow of the government in 2021 have only served to underscore this reality. Expecting Washington, insurance companies, and a pharmaceutical industry where billions of dollars are being made every day to change in ways that improve life for those who struggle with mental illness is a fantasy people who struggle on a daily basis can’t afford to entertain.

While it’s encouraging to see more open dialogue about the importance of mental health, Taylor Swift singing about her depression doesn’t help someone who is having a panic attack or on the verge of suicide and has just been told the soonest they can see a psychiatrist or therapist is in three months.

To be clear, I love Ms. Swift’s work, and to prove it, lets take a break from all the bad news and watch ‘Antihero’ for the billionth time.

“When my depression works the graveyard shift
all of the people I’ve ghosted stand there in the room”

Taylor swift- antihero

When artists like Taylor Swift, Metallica’s James Hetfield, Phoebe Bridgers, or comedian Pete Holmes talk about their challenges with mental health, it shows people who might be struggling themselves that they aren’t alone. When artists create something that acts as an antidote to the stigma surrounding mental health, it’s a reason to celebrate.

I’ll cede the point that ‘no one is coming to help’ isn’t 100% accurate. Taylor, Phoebe, James, Pete, and an army of dedicated nonprofit mental healthcare professionals are helping a great deal. It’s probably more accurate to say that no one who can lower our health insurance premiums or the cost of psychiatric medication is coming to help. I think I have that part right.

That said, songs and stand-up comedy dealing with depression, anxiety, or addiction have yet to do much to change the fact that wait times to see a mental health provider can extend out as far as six months.

Art and creativity are powerful forces in society, but they haven’t stopped large healthcare systems from systematically shutting down desperately-needed inpatient behavioral health facilities in order to cut costs, leaving patients without access providers. Corporate awareness programs are well-intended and appreciated, but haven’t caused pharmaceutical company executives to realize charging $87.00 for single 10-milligram tablet of escitalopram (Lexapro) is vile and disgraceful.

The tireless work of the mental health non-profit sector doesn’t even register on the health insurance industry’s ethical radar, assuming they even have an ethical radar, which is unlikely. Despite the disingenuous virtue signaling featured in their advertising, insurance companies are too busy building new claim denial algorithms to actually care about the person who is considering suicide but can’t access care. Pharmaceutical and insurance companies are no more “in it together” with us than JP Morgan Chase or Exxon are, and until it is no longer possible to profit off of the misery of others, the overall impact of awareness will remain limited.

So, while art, music, comedy, literature, and philosophy are bringing a long-neglected health issue out of the shadows, over 50 million Americans still have diagnosable mental health illnesses and only one out of five of them can receive the treatment they need. That this number that has not declined since 2011 points to the limited impact more awareness has had on the hearts and minds of those writing healthcare legislation, manufacturing drugs, and pricing insurance plans.

After years of struggling to access adequate mental healthcare services, I realized, that despite the efforts of many well-meaning people, substantial reform of the type and comprehensiveness that would have a meaningful impact on my treatment journey is unlikely to be available in my lifetime or the lifetime of my son. I hope I’m wrong, and will happily admit it when given reason to do so, but in the near term I don’t think I am.

Stoic philosophy calls us to expect the worst and rejoice at the best, and this idea is threaded throughout the DIY processes and recommendations I make to people who struggle with mood disorders.

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